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Drugs to relieve migraine

Migraine attacks (see Migraine) produce severe headaches and are often accompanied by nausea and vomiting. These symptoms may be preceded by visual disturbances. Some drugs used to treat migraine are taken regularly to prevent attacks, while others are taken during an attack to alleviate the symptoms. Painkillers may help to relieve headaches.

How do they work?

During a migraine attack, blood flow inside the brain changes. Initially, the blood vessels narrow, reducing blood flow. After this initial phase, the vessels rapidly widen, and a severe headache develops. Drugs that are used to prevent migraine, such as propranolol (see Beta-blocker drugs), prevent these changes in blood vessel size. However, the exact mechanism by which they work is not understood.

Triptan drugs, such as sumatriptan and naratriptan, and ergotamine relieve the symptoms of a migraine attack by returning widened blood vessels to their normal size. Painkillers can provide some relief if taken early in a migraine attack.

How are they used?

Most people who experience migraines have attacks infrequently and can control the pain by taking drugs such as paracetamol, aspirin, ibuprofen, or codeine. If you experience frequent, severe migraine attacks, your doctor may recommend that you use a preventive drug, such as the beta-blocker propranolol, to be taken daily for a few months.

Severe migraine that is not relieved by painkillers may respond to triptans or ergotamine. You should take these antimigraine drugs as soon as you notice symptoms developing. Triptans and ergotamine can be taken orally, but if you regularly experience episodes of very severe migraine, especially if they are accompanied by nausea and vomiting, your doctor may prescribe triptans in a form that can be given by injection or nasal spray. Ergotamine is also available as a suppository.

There are various over-the-counter preparations for migraine. These may contain one or more painkillers and an antiemetic drug to help to relieve nausea and vomiting.

What are the side effects?

You may experience side effects when taking drugs to treat migraine. Taking propranolol may cause cold hands and feet and tiredness. Triptans can make you feel drowsy and can sometimes cause flushing, dizziness, tingling sensations, and chest pain. Ergotamine may cause nausea, vomiting, abdominal pain, diarrhoea, and muscle cramps. Excessive use of triptans or ergotamine may reduce their effectiveness. You should not exceed the recommended dose of any antimigraine drug.